I’m surprised that particular aspect of the side effect profile comes into play with acute usage.

Well obvs. It’s basically,“idk which receptor is making them _____ (punch people, refuse to eat or drink, or whatever other immediate harm to themselves / others), but we need it to stop 3 days ago and can figure out the details or a potential cross-taper to something better later.”

Ah, yes, this happens a lot. No, I don’t work in the medical field at all. I just know things, for reasons.

Color me fascinated, lol. My guesses are personal experience / reading up on your own treatment or that of a loved one, tangential relation to the field such as clinical research, or just plain personal fascination. Given you linked to a drug that appears to be in trials my first guess is actually the second one. Hadn’t heard of it, and I’m hopeful, but after seeing abilify get approved for acute agitation I’m… skeptical.

i.e. the psychosis has done so much cumulative damage at this point that you need to fall back to the typicals. That explains why the third-gens are useless.

Yeah a lot of people don’t realize the damage is additive, both people w/ these disorders and unrelated laypeople who think “talented artist stops taking their meds and continues to be talented but starts creating art with weirder subject matter as their brain boils” is a cool story.

I’m mostly replying to add though that risperdal also has the distinction of being avaliable as a long-acting injectable, and if you’re trialing oral meds before committing to an LAI, your options are somewhat narrowed. Zyprexa does have an LAI available, but I’ve actually never seen it used and while I can’t tell you why for certain, I do have a guess.

If you have a patient sick enough that you’re considering an LAI, you don’t want to take benzos off the table for an entire month, especially if it turns out to be inadequate after discharge and they wind up in an ED agitated and unable to report their own med hx and get B52ed and stop breathing. I’ve had a pharmacist tell me considering that interaction is going out of style but a history of that kind of adverse event is difficult for a med to shake. Accutane still has suicidal ideation in adolescents listed as a side effect but I have a strong suspicion that it’s less causation and more correlation with the impact of pizza face on the self and social esteem of a teenager.

Dude sometimes we still give thorazine. And tbh ime the 3rd gens don’t do shit for my typical patient. For context also though, I’m essentially providing ICU level care, so when you say the word “symptom control” it’s often referring to like, fists.

We had a Lady maxxed on Haldol BID one time and she managed to cheek for a week and eventually she just hauled off and rapid fire punched a nurse in the head three times. She legit thought a man was entering through her window every night on a beam of light to forcibly impregnate her and deliver the baby. She kept demanding to see the 50 babies she had up on L&D from the past few months. I’ve actually seen quite a few pregnancy delusions and they’re almost always completely wild psychosis. Another was such an angry manic but high insight enough that when she couldn’t take it anymore she would just come scream at me for the thorazine.

I’m unsure if you don’t work inpatient psychiatry or you just work somewhere significantly classier than I do. I do work in an inner city area that’s flush with people stuck in a cycle of drugs / homelessness so I’m also not going to tell you that any of this is the best solution, just that it’s the only one avaliable to any of us right now due to shitty government policies.

To the extent that men can lactate! It’s one of the possible side effects of risperdal, which I have to be aware of because I give it fairly regularly. It’s all the same structures it’s just a matter of the hormone signals they’re getting.

an oldie but goodie

Well you don’t want food service workers wearing gloves for the most part. Nonsterile gloves protect the wearer much more than anything they’re touching and food should be the opposite of chemically unsafe to touch. Gloves can also undermine a focus on or even specifically discourage regular handwashing which is what actually keeps food and food prep equipment clean / sanitary. Unless you have cuts, sores, warts or some other infection on your hands, gloves are the least helpful solution to keeping food sanitary.

That said, I doubt he washes his hands adequately and the whole hairnet thing is gross AF, especially with that glued-on dead animal he calls hair.

I just get feisty about the gloves thing because I remember during the pandemic when my hospital was struggling to keep gloves in stock for us to handle blood and bodily fluids with, and one day in an urgent care I saw a patient in the waiting room wearing gloves reach up and run his gloved hands through his hair. I almost just screamed at him. They’re not magic clean hand socks you have to use them properly and in the right situations.

It’s usually a team effort. Usually when we’re disagreeing it’s some tiny little thing like how much sedation or pain or anxiety medication is needed, or which specific modality of treatment is indicated for something. The pain and anxiety thing can also go either way, sometimes it’s the nurses wanting more meds for the patient and sometimes they’re thinking less should be used and same for the doctors. And the other common disagreement is usually a disagreement of statistics vs lived experience, so the doctors are looking at the big picture of how things play out across large populations in places across the country or even world, vs nurses are thinking more in terms of their specific population and environment and what their specific team is trained and experienced at pulling off. Big picture vs individualized. There’s also some overlap though, they’re pushing more nurses especially in higher ed to learn more about stats and they’re pushing doctors to individualize things to their patients and teams.

This is all to say that there are a lot of extreme moments where we’ll both just look at each other like what in the actual fuck is happening. We don’t always agree on the exact solution but we can usually at least come to a rapid consensus that what is currently happening is unacceptable.

I was gonna say, their poor families! Here’s oping they get away clean and make it count!

Its like gentle passive parenting with 0 proffesional assistance when your kid has conduct disorder (pediatric precursor to antisocial personality, the newer, updated version of psychopathy). “Can you please put the knife down sweetie? Knives make people sad!”

And justice being served eventually also doesn’t help the person get the care they need in a timely manner. Abortions are safer when done earlier in the pregnancy, and often there are more legal hoops that have to be jumped through later in the pregnancy if they’re not barred altogether. A court case settled a year or more later doesn’t do much to help a woman who needs care now whether it’s for immediate physical safety or to prevent her body from being used for life support for another person without her consent.

Not that this makes them any less brave but I suspect many of them know they’re next. The same people that want the Palestinians dead are the same people that want them dead eventually too, its just easier to let Israel handle Palestine for them first. They’ve stopped talking about Jewish space lasers juuust long enough to slander people who don’t support Israel as antisemetic.

Honestly my biggest issue is getting randomly banned from trans spaces for expressing my own lived experience with surgery and how I view my own body and gender. They’re so “inclusive” that they start excluding people that don’t use their very specific language or share their beliefs exactly. They keep kicking people out then wondering where all the people went!

“Plenty of staff” I’m calling bullshit right there. I don’t work corrections but I used to work forensic psych and they were the only part of that institutional system with worse staffing than us.

I wonder if this is due to gobal climate change or local efforts towards sustainable farming and forestry to reclaim areas the Sahara has encroached on in recent years. Could be both.

The onion strikes again!

Any nurse who’s had their ass beat by a dementia patient at 2am could tell you this.

I love nurse Johnn btw, “mr. smith” is (usually) his character w dementia.

• The witching hour

• General nonsense

• Mr smith in the ceiling again

• But maritas gonna go get him

Was about to ask for a different state lol

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